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M. C. Herwig, A. Vogel, F. G. Holz, K. U. Loeffler; Pilomatrixoma of the Eyelid: Clinical and Histologic Analysis in 13 Cases. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5692. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Pilomatrixoma (PM, benign calcifying epithelioma of Malherbe) is a rare benign tumor originating from the matrix of the hair root. In this study, we evaluated the clinical and histopathological characteristics of all the respective tumor specimens submitted to our laboratory since 1997.
We reviewed the clinical and histologic findings of 13 PMs localized to the eyelid or periocular region. Paraffin sections were stained with H&E and PAS and in addition, immunohistochemistry was performed using markers for macrophages (CD68), for proliferative activity (Ki 67), and for proliferation/apoptosis (CAS/CSE1L).
Eigth of the 13 patients were male. The mean age at the time of diagnosis was 35 ± 27,5 years (range: 4 to 84 years). All 13 PMs were localised on the upper eyelid and/or near the eyebrow, measuring between 96 mm³ to 1440 mm³ (average: 590,6 ± 455,9 mm³). Most PMs (n=10) revealed a reddish or bluish coloration. In 3 cases the correct diagnosis was made intraoperatively, while no PM was diagnosed prior to surgery. The most frequent false diagnoses were retention cyst (n=3), atheroma (n=2), and abscess (n=2). There was no tumor recurrence in any of the cases within the time period presented.All 13 PMs demonstrated the characteristic histology with areas of basophilic and shadow cells in varying amounts as well as calcification and keratinous material, all surrounded by a pseudo-capsule. Usually, the shadow cells were dominating. Numerous macrophages, foreign body giant cells and chronic inflammation were found in 11 cases, sometimes even exceeding the amount of shadow cells. In 3 specimens, 7 to 10 mitoses were found per visual field (x20) while the remaining tumors did not show a significant mitotic rate. With anti-Ki67, a positive labelling was localized mostly to the peripheral basophilic cells, thus indicating a regular epithelial maturation. With anti-CAS/CSE1L, staining was more widely distributed, possibly preferring the inner areas of basophilic cells.No correlation was found between any of the histologic or immunohistochemical markers and clinical parameters such as size, age and gender of the patient and time of tumor presence prior to surgery.
This case series represents the third largest published so far, underscoring that PM can appear at any age. While it is usually not recognized clinically, it should be considered in the differential diagnosis especially for tumors of the upper eyelid. Our immunohistochemical findings support the basically benign nature of PM but also point to the chronic inflammatory stimulus that can lead to complications after incomplete removal.
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